This on-line form cannot be partially completed and saved. Your registration will be accepted when your form has been completed and paid. All class participants must be current members of U.S. Figure Skating.

Registration Deadline: May 5

Skater Information

Skater First Name(*)

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Skater Last Name(*)

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Skating Club(*)

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Skater's age at the time of camp: (*)

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USFSA #(*)

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Current USFS Moves in the Field Test Level(*)

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Current USFS Freeskate Test Level(*)

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Jump Level(*)

1-2 Single Jumps

3-5 Single Jumps

Starting Axel

Clean Axel

1-2 Double Jumps

3-5 Double Jumps

Starting Double Axel

1-2 Triples

3-5 Triples

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Please check the jump box that applies to your skater. Your skater must be able to SOLIDLY and CONSISTENTLY land the jump 4 out of 5 times. (If you are unsure, PLEASE consult with your coach)

Primary Coach's Name

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Contact Information3>

Purchaser Full Name(*)

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Email Address(*)

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Primary Phone Number(*)

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Secondary Phone Number

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Private Lesson Information and Request3>

Preferred Number of Private Lessons(*)

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$42 for one 20-Minute Lesson. Fees to be collected after the lesson schedule is released.

We will do the best we can to match you with your coach requests, but we do NOT guarantee all of your requests.

Preferred Coach

Audrey Weisiger

Nick Perna

Chris Conte

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2nd Choice Coach

Audrey Weisiger

Nick Perna

Chris Conte

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Semi-Privates

I am interested in semi-private lessons with 1-2 other skaters at the same skating level.Invalid Input

Additional Information

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Waivers

Seminar Participation Liability Waiver

In consideration of being allowed to participate in any way in the Grassroots To Champions, (the “seminar”), related events and activities, including but not limited to programs at the camp and off ice, I hereby agree/give my consent for myself/my child (as parent or guardian) to participate.

I acknowledge that ice skating is inherently dangerous. I agree that Grassroots To Champions, St. Louis Skating Club, Brentwood Ice Rink and the City of Brentwood, their agents, servants, and employees shall not be liable to me (my child) for any injury or damage, however caused, resulting directly or indirectly from my child’s participation in the camp whether incurred on the ice or otherwise, in or about the buildings, at any time preceding, during, or subsequent to the camp, and I hereby discharge Grassroots To Champions, their agents, servants, and employees from all actions, claims and demands I (my child) may have for any such injury or damage.

I further acknowledge and agree that Grassroots To Champions and seminar do not insure, and will not be expected, at any time, to insure the safety or the proper state of repair of my child’s equipment used by my child during the seminar and that Grassroots To Champions does not, and shall not be considered to, guarantee or warrant the instructional materials used by it during the seminar.

I also understand that my agreement, releases, and discharges herein shall bind my heirs, legal representatives and assigns and shall endure to the benefit of Grassroots To Champions, St. Louis Skating Club, Brentwood Ice Rink and the City of Brentwood, their agents, servants, and employees, and their successors and assigns.

Agreement(*)

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Consent for Medical Attention or Treatment

I certify that I, the member, or I, the parent/guardian of said participant, give my consent to the St. Louis Skating Club and the facility the activities are taking place and their staff and to members of the St. Louis Skating Club, their Board of Directors and volunteers to obtain medical care from any licensed physician, hospital or clinic, including transportation and emergency medical services, for myself/ourselves and/or said participant for any injury that could arise from participation in these activities. This consent for Medical Attention shall be binding and effective for the Summer 2017 Grassroots to Champions Seminar of St. Louis Skating Club.

Agreement(*)

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CITY OF BRENTWOOD ICE RINK HARNESS USAGE AGREEMENT

The User noted below has requested to use the ice rink harness belonging to the City of Brentwood at the City’s Recreational Center from time to time during the next year as part of his/her activities with St. Louis Skating Club.

In consideration for the privilege of using the ice rink harness at the City of Brentwood’s Recreational Center from time to time during the next year, the User and, if User is a minor, his/her parent or guardian, hereby agree to release and hold harmless the City of Brentwood and, further, indemnify the City with regard to all injuries and damage resulting from User’s use of the ice rink harness. Specifically, the undersigned agrees as follows:

THE CITY OF BRENTWOOD SHALL NOT BE LIABLE FOR PERSONAL INJURY
OR FOR DAMAGE TO OR LOSS OF PERSONAL PROPERTY IN OR ABOUT THE ICE RINK, REGARDLESS OF THE CAUSE OF SUCH INJURY, LOSS OR DAMAGE.

USER AND, IF USER IS A MINOR, HIS/HER PARENT OR GUARDIAN, FOR HIMSELF/HERSELF, USER’S HEIRS, EXECUTORS, ADMINISTRATORS, APPROVED SUCCESSORS AND ASSIGNS, HEREBY RELEASES, RELINQUISHES AND DISCHARGES AND AGREES TO INDEMNIFY, PROTECT AND SAVE HARMLESS THE CITY OF BRENTWOOD, ITS GOVERNING BOARD, OFFICIALS, EMPLOYEES AND REPRESENTATIVES, FROM ANY AND ALL CLAIMS, DEMANDS AND LIABILITY FOR ANY INJURY TO, INCLUDING DEATH OR, PERSONS AND ANY LOSS OF OR DAMAGE TO PROPERTY (WHETHER THE SAME BE THAT OF EITHER OF THE PARTIES HERETO OR OF THIRD PERSONS) CAUSED BY, GROWING OUT OF OR HAPPENING IN CONNECTION WITH, USER’S USE OF THE ICE RICK HARNESS.

FURTHERMORE, USER / USER’S PARENT OR GUARDIAN AGREES TO RELEASE, EXONERATE AND HOLD HARMLESS THE CITY OF BRENTWOOD, ITS GOVERNING BOARD, OFFICIALS, EMPLOYEES AND REPRESENTATIVES, FROM ANY AND LIABILITY EVEN THOUGH THE CLAIM, OR LOSS OR CASUALTY IS ATTRIBUTABLE TO THE NEGLIGENCE OF THE CITY OF BRENTWOOD, ITS GOVERNING BOARD, OFFICIALS, EMPLOYEES OR REPRESENTATIVES.

Furthermore, User agrees to comply with all other usage policies as promulgated by the City of Brentwood relative to the ice rink and the ice rink harness.

Agreement(*)

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Media Release

On occasion, newspaper reporters or figure skating websites ask to interview or take pictures of seminar participants. Pictures and/or information about the seminar will be posted on the Grassroots To Champions website. Grassroots To Champions periodically uses photographs and video footage of seminar participants in its advertising/marketing material. This media release statement will serve as permission to use such information as needed.

I acknowledge and agree that Grassroots To Champions, St. Louis Skating Club and figure skating partners, reserve the sole and exclusive rights to use any photographs or video taken during the seminar for advertising and/or instructional purposes, without cost or charge whatsoever to Grassroots To Champions or it's partners.

Agreement(*)

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Seminar Payment

Wednesday Seminar Fee(*)

St. Louis SC Member - 150.00 USD

Non-Member - 175.00 USD

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"St. Louis SC Member" includes Associate members.

Total

0.00 USD

Payment

If you experience problems with the online registration form,
please contact This email address is being protected from spambots. You need JavaScript enabled to view it..

Our Mission

The mission of St. Louis Skating Club is to promote, encourage and improve all areas of amateur skating, in all disciplines. St. Louis Skating Club encourages a fraternal feeling among ice skaters and strives to raise the standard and level of figure skating by encouraging testing and competitive skating and by providing skaters access to qualified club-approved coaches.

501(c)(3)

St. Louis Skating Club is a charitable organization under Section 501(c)(3) of the Internal Revenue Code. Any gift you make is tax-deductible to the maximum extent allowed by law.